Wednesday, 28 October 2015

Private sector engagement in Sanitation and Hygiene


Sanitation and hygiene interventions have the objective of ending open defecation and enabling access to safe sanitation by households.  This is reflected in the SDG target 6.2 which aims to “achieve access to adequate and equitable sanitation and hygiene for all by 2030”.

Sanitation marketing is applicable to both rural and urban settings and combines a behavior change communication component to encourage the adoption of improved and hygienic latrines with a commercial component for developing the right products and services for consumers that are accessible to households at affordable price points.Sanitation marketing therefore requires strong partnerships and coordination of various government departments, development partners, entrepreneurs and financiers with households/consumers at the center.

Split into three inter-linked and sequenced sub-themes that explore links between research and practice, the discussion focuses on how and under what circumstances local private sector engagement can ensure sustained health and WASH outcomes. Thematic experts will frame and prompt debates each week as follows:

Step 1: 

Raising demand for sanitation and hygiene services: will focus on working with the private sector to raise demand through sanitation marketing and financing options including access to household credit, financing for local entrepreneurs or via other means. We are keen to explore forum members’ insights and experiences on the following: 

Considering the SDG target 6.2, how can sanitation marketing approaches be designed most effectively to increase the percentage of populations using safely managed sanitation services in urban and rural settlements?  What are appropriate roles for the local private sector in supporting these efforts?

Experience and formative marketing research has shown that households do not prioritise sanitation financing.  How do we structure micro-credit financing to make it attractive for households to take small loans for sanitation?

In both rural and urban settings, how do we best link CLTS and sanitation marketing in practice and what sequencing of interventions is required?

What approaches to finance can help low-income urban settlements to access safely managed sanitation services?  What are the enablers and barriers to this?

Step 2: 

Meeting demand at the household level:will focus on engaging local entrepreneurs to respond to demand through local entrepreneur engagement around toilet construction and emptying.

Step 3:

Engaging private sector further along the chain: will focus on local private sector roles in transport, disposal and reuse

For each area, key questions revolve around the business models and financing options that hold promise, the role of government and external agencies in enabling and supporting enterprise development, and the design of appropriate regulation for small and medium enterprises.


Tuesday, 20 October 2015

Sanitation in Mahatma Gandhi’s words....

It’s been exactly a year since Indian Prime Minister NarendraModi launched the “Swacch Bharat Abhiyan,” or “Clean India Mission,” to honor India’s independence leader, Mahatma Gandhi on the anniversary of his birth.

The aim of the nationwide cleanliness drive: to clean up the country by 2019, the year that marks the 150th anniversary of the birth of Gandhi, who wanted to make sanitation a priority for India more than a century ago. The current drive aims to end the wide-spread practice of open defecation, build more toilets and improve waste management, among other goals.

Gandhi strongly and repeatedly condemned the Indian practice of hiring people from the lowest rungs of the Hindu caste system, who were once called “untouchables,” to manually clean out primitive dry latrines or collect waste from fields where villagers relieved themselves,  urging his countrymen to clean up after themselves.

Although outlawed, “manual scavenging” continues to persist in India as do other infrastructure failings hindering efforts to improve sanitation in the country. Almost half the population still defecates in the open, and the practice is more prevalent in the countryside where government figures indicate almost 70% of households don’t have access to proper toilets.

Here are some of Gandhi’s thoughts on sanitation and cleanliness as they appear in a 2012 book titled “Music of the Spinning Wheel” by Sudheerna Kulkarni.

1  Sanitation is more important than political independence’

While leading a non-violent movement for India’s independence from the British in 1947, Gandhi spoke about the need to improve hygiene and cleanliness in the country. “Sanitation is more important than political independence,” he said. Last month, in an address on waste management and cleanliness, India’s President Pranab Mukherjee, reiterated Gandhi’s decadesold exhortation.

2 Religion and sanitation

In 1915, Gandhi went to the KumbhMela, a triennial festival that rotates between four Indian cities. That year, it was held in the Hindu holy city of Haridwar in India’s north on the bank of the River Ganges.
After seeing millions of devotees take a dip in the sacred river in attempt to wash away their sins, Gandhi later wrote in “Young India,” an English weekly he edited from 1919,“I had gone there full of hope and reverence. But while I realized the grandeur of the holy Ganga and the holier Himalayas, I saw little to inspire me in what man was doing in this holy place.”

“To my great grief, I discovered insanitation, both moral and physical…There is defilement of the mighty stream [the River Ganges] even in the name of religion,” he wrote.
“Thoughtless ignorant men and women use for natural functions the sacred banks of the river where they are supposed to sit in quiet contemplation and find God. They violate religion, science and the laws of sanitation.”

[Click here to see the filth left behind in the river by millions of pilgrims who attended the KumbhMela in the northern Indian city of Allahabad in 2013.]
Cleaning the River Ganges has been the national priority of the Indian government for years now. In May, under the leadership of Mr. Modi, India’s cabinet approved 200 billion rupees, about $3 billion, for a program aimed at cleaning the Ganga.

3 'A lavatory must be as clean as a drawing-room'

In May 1925, in an edition of “Navajivan,” a weekly newspaper that Gandhi edited from 1919, he wrote about the importance of keeping lavatories clean. “I learnt 35 years ago that a lavatory must be as clean as a drawing-room. I learnt this in the West,” he wrote.
“The cause of many of our diseases is the condition of our lavatories and our bad habit of disposing ofexcreta anywhere and everywhere. I, therefore, believe in the absolute necessity of a clean place for answering the call of nature and clean articles for use at the time.”

4 Perfect sanitation makes an ‘ideal village’

In 1937, Gandhi received a letter from a villager living in Birbhum, a district in India’s eastern state of West Bengal. The letter writer asked Gandhi how he perceived an “ideal village” and what problems he thought plagued Indian villages.
Here’s his response, as it appeared in a 1937 edition of “Harijan,” another weekly publication, which Gandhi began editing in the early 1930s. “An ideal village will be so constructed as to lend itself to perfect sanitation…The very first problem the village worker will solve is its sanitation,” he wrote.
“If the worker became a voluntary scavenger, he would begin by collecting night soil and turning it into manure and sweeping village streets. He will tell people how and where they should perform daily functions and speak to them on the value of sanitation and the great injury caused by its neglect. The worker will continue to do the work whether the villagers listen to him or not.”

5 Sanitation for Ministers and Menials Alike

In a speech in New Delhi in September 1946, Gandhi stressed the need for equal levels of hygiene in bungalows that ministers lived in as well as the servants’ quarters tucked away in these massive houses. “What is so distressing is that the living quarters of the menials and sweepers employed in the viceroy’s house are extremely dirty…I shall be satisfied only when the lodgings of the ministers’ staff are as neat and tidy as their own,” he said.

Indians Can’t Stand to Use the Toilet, why?

Indian children walked to defecate in an open field in a northern village in the Badaun district of Uttar Pradesh, Aug. 31.

India has a problem with toilets: Every second person relieves themselves outdoors, a centuries-old practice that contributes to child malnutrition, economic loss and evenviolence against women.
It’s a problem that India’s Prime Minister NarendraModi wants to fix by making sure every home in the country has a toilet of its own by 2019.

The answer though, sanitation experts say, doesn’t lie only in building more bathrooms. First, people need to learn to love using the latrine.

“Many people regard open defecation as part of a wholesome, healthy, virtuous life,” a recent study conducted in Bihar, Haryana, Madhya Pradesh, Rajasthan and Uttar Pradesh found.  Researchers at the New Delhi-based Research Institute for Compassionate Economics added that the practice is “not widely recognized among rural north Indians as a threat to health.”

Those five northern Indian states account for 45% of the country’s households without a toilet, according to data from the 2011 census. But even in homes where toilets were installed, many people still prefer to go outside.

The RICE study found that out of 3,235 rural homes, 43% had a working toilet. Of those, over 40% had at least one member of the household who nevertheless opted to defecate in the open. When asked why, almost 75% said they did so because it was pleasurable, comfortable and convenient.
The government says it has recognized that it needs to address this mindset making it “top priority” while setting out to build 110 million new toilets across swathes of rural India in the next few years.
The full policy has so far not been published but will include a door-to-door campaign similar to that used in the eradication of polio.

When you get down to brass tacks though, the picture looks slightly less positive.
To build toilets across India’s cities and villages, over $30 billion has been earmarked, a large chunk of it provided by the federal government.

But only 8% of this money will go towards what the government calls “information, education and communication,” or IEC.

Experts say that’s too little.

“I would spend at least half of the money on IEC,” said SantoshMehrotra, a professor of economics at New Delhi’s Jawaharlal Nehru University.

“The IEC strategy is the heart and soul of a sanitation scheme to bring real change on the ground,” he added.
Previous sanitation programs in India have failed to spend all the money allocated.

SangitaVyas, one of the authors of the RICE study, said this is partly because of the red tape involved in getting education campaigns approved. She worries it will be the same for Mr. Modi’s new mission.

When the money is spent, it’s not all being put to good use: Researchers point out that the government has failed to inform people about the adverse health effects of open defecation as it has done in campaigns to reduce tobacco and alcohol consumption.

In the past, India has also relied on subsidies to get people to embrace toilets and handouts will play a big part in the new program, Mr. Mehrotra added.

The result? “Toilets that are not being used for what they are meant for and instead are made into storage rooms,” he said. “With subsidies, they go back to their bad habits after they have received the prize.”

India could learn from its neighbor Bangladesh when it comes to eradicating open defecation without relying on incentives.

In 2000, that country introduced a program in which health workers would encourage communities to identify the consequences of poor sanitation, spurring them to want to build toilets for themselves. The focus was to alter behavior before building the infrastructure to accommodate the change.
Known as community-led total sanitation and pioneered by Indian-born development consultant Kamal Kar, it is now in place in more than 50 countries, including in parts of India.

The method has reduced the number of people in Bangladesh defecating in the open from 19% in 2000 to 3% in 2012.

But it’s not perfect. CLTS does not define what makes a good toilet and regards access to a toilet, even a poorly built one, as better than not using one at all. Often in Bangladesh, a toilet can be just a shallow pit covered by two wooden planks. This pit is able to store human waste, but is often washed away during heavy rains and floods, increasing the risk of contracting diseases like diarrhea and cholera. That’s why the focus there has now shifted to manage the disposal of waste collected in the country’s toilets.

In India, the challenge remains to get people to use them at all.

India's Health and Rural women's safety at risk due to lack of Toilets

In the village where two girls were gang-raped and hanged earlier this year, toilets may help protect women and health

In the evening gloom of their dirt courtyard, Raj Beti and her six daughters are growing desperate. They last answered nature's call 13 hours ago, but it's not yet dark enough to venture into the fields.
For generations, most of the 750 families in Katra, in Uttar Pradesh, northern India, have lived without toilets. They've grown used to holding their bladders and bowels, being stalked by wild boars and hyenas and, during the rainy season, watching out for snakes.

But since 27 May, when two girls, 14 and 15, were found gang raped and hanged after they went to relieve themselves in the dark, Katra's residents have been gripped by a new fear.
"There are no crops now, nowhere to hide, and men can see us from all sides," explains Raj Beti, as a teenage daughter stirs a potato curry over a wood fire, while her youngest, Soumya, two, plays hide and seek in a tattered Teletubbies dress. "We don't know who's watching, who's waiting for us."

Like many rural Indian families, Raj Beti and six daughters cannot afford a toilet.

Since the murders, the dead girls' families have a police escort when they use the fields, but millions of other Indian villagers and slum dwellers do not have that luxury.

India leads the world in open defecation. At least 636 million Indians lack toilets, according to the latest census data, a crisis that contributes to disease, childhood malnutrition, loss of economic output and, as highlighted recently, violence against women.

The issue is so critical that it featured prominently in NarendraModi's first Independence Day speech, in which the prime minister said India should ensure there were toilets for all within four years. "We are in the 21st century and yet there is still no dignity for women as they have to go out in the open to defecate and they have to wait for darkness to fall," Modi said. "Can you imagine the number of problems they have to face because of this?"

India's government has allocated nearly £1bn over five years to build toilets, but a tour of Katra shows the money has made little difference.

Maya Devi, whose government-built toilet is no longer usable. 

In Maya Devi's home, the bowl of the government-built latrine is cracked and the cubicle's door has blown off. But poor aesthetics are not the main problem. "The pit is full," said Maya Devi. "We don't know how to empty it so we've started using the fields again."


However, help is on the way. Spurred by private donors worldwide reacting to the murders, the charity Sulabh International, which builds pay-as-you-go lavatories in India's urban slums, has pledged to provide more than 400 toilets in Katra. Ramesh Mishra, a civil engineer, has been posted in the village for the past month, overseeing construction of the first 108 composting toilets in the poorest homes. Each one is designed to be used with minimal water, to be easily cleanable with stone floors and tiled walls, and to last for decades without any special maintenance.

Mishra has become Katra's most popular man and is trailed wherever he goes. "I have six daughters," Raj Beti harangues him. "You're building toilets for others, why not me?"

"It's unfortunate that it took a terrible crime to change attitudes," Mishra said, explaining that some villagers will have to wait for the next phase of construction. "But at least now they all want toilets."
Across the rest of India, promoting toilet use is still a struggle. A survey released in June showed that 40% of households with a working latrine still had at least one person who regularly defecates in the open and that half of them said they did so because it was pleasurable, comfortable and convenient.

"Among women, toilets figure in the top three needs for their own security and health," said HariMenon, deputy director of India programmes for the Gates Foundation. "It's a much bigger problem with the men. They see their responsibility as just building a toilet, not using it."

Toilet bowls waiting to be installed in Katra by Sulabh International.

Experts say India's emphasis must shift to educating people on the need for better sanitation.

"In India, a large, hierarchical bureaucracy is attempting to do a job that a good advertising agency could do," said YaminiAiyar, from the Accountability Initiative of the Centre for Policy Research in New Delhi.

She points to simple educational tools that could be employed.

"There are tiny strips available to test bacterial contamination of water. You dip it and it will go from being totally clean to completely black, which powerfully illustrates to people that there is really something wrong with their water if they don't practise sanitation," Aiyar said.

India could also learn valuable lessons from poorer neighbours such as Bangladesh, which has cut rates of open defecation from 19% to 3% in just two years by decentralising sanitation programmes.
The UN's eight millennium development goals include halving the proportion of people who do not have access to sanitation facilities by 2015. But India's high open defecation rates have slowed down progress.

There are few organisations like Sulabh with the expertise necessary to build low-cost, environmentally sound and user-friendly toilets. To spread sanitation, Sulabh's founder, DrBindeshwarPathak, said he needed an army of "toilet missionaries".

"If we trained 30,000 young people in building good toilets, in health, in basic sanitation at the village level, if every politician and industrialist pledged to pay for one toilet, then there could be progress," said Pathak. "We need freedom from dirt and filth, but everyone will have to participate."
In Raj Beti's courtyard, the evening light fades, leaving her face in shadow. She balances Soumya on one hip and she and her older daughters head single-file towards the fields.

To the chirrup of bullfrogs and crickets and the occasional cry of a peacock, they march past the last dwelling in the village to a fallow field.

Shrouded in darkness, the girls spread out, pulling down their baggy shalwars. They're frightened, uncomfortable and trying to hurry up as a tractor shudders past about 20 metres away, driven by men.
As they wash and walk back to the village, other girls and women appear in pairs and small groups from the gloom.

Outside his home, now guarded by six constables, SohanLal, the father of the 15-year-old girl who was raped and killed, said that for him, improved sanitation was as important as obtaining justice for his murdered daughter. "We don't want to see this happening to another family," he said. "I wouldn't be able to tolerate it."

History of Toilets - Ancient Civilizations...

Ancient civilizations

Stone toilet found in 8th century BC house in the City of David, Jerusalem.

According to Teresi et al. (2002)

The third millennium BC was the "Age of Cleanliness." Toilets and sewers were invented in several parts of the world, and Mohenjo-Daro (see sanitation of the Indus Valley Civilization) circa 2800 BC had some of the most advanced, with lavatories built into the outer walls of houses. These were primitive "Western-style" toilets made from bricks with wooden seats on top.

They had vertical chutes, through which waste fell into street drains or cesspits. Sir Mortimer Wheeler, the director general of archaeology in India from 1944 to 1948, wrote, "The high quality of the sanitary arrangements could well be envied in many parts of the world today."

  Roman public toilets, Ostia Antica.

The toilets at Mohenjo-Daro, built about 2600 BC and described above, were only used by the affluent classes. Most people would have squatted over old pots set into the ground or used open pits. The people of the Harappan civilization in Pakistan and northwestern India had primitive water-cleaning toilets that used flowing water in each house that were linked with drains covered with burnt clay bricks. The flowing water removed the human waste.

Early toilets that used flowing water to remove the waste are also found at Skara Brae in Orkney, Scotland, which was occupied from about 3100 BC until 2500 BC. Some of the houses there have a drain running directly beneath them, and some of these had a cubicle over the drain. Around the 18th century BC, toilets started to appear in Minoan Crete, Egypt in the time of the Pharaohs and ancient Persia. In Roman civilization, toilets using flowing water were sometimes part of public bath houses.

In 2012, archaeologists founded what is believed to be Southeast Asia's earliest latrine during the excavation of a neolithic village in the RạchNúi archaeological site, southern Viet Nam. The toilet, dating back 1500 BC, yielded important clues about early Southeast Asian society. More than 30 preserved feces from humans and dogs containing fish and shattered animal bones from the site provided a wealth of information on the diet of humans and dogs at RạchNúi and on the types of parasites each had to contend with.

Model of toilet with pigsty (see Pig toilet, China, Eastern Han dynasty 25 - 220 AD)

Roman toilets, like the ones pictured here, are commonly thought to have been used in the sitting position. But sitting toilets only came into general use in the mid-19th century in the Western world.[38] The Roman toilets were probably elevated to raise them above open sewers which were periodically "flushed" with flowing water, rather than elevated for sitting.

The Romans weren't the first civilisation to adopt a sewer system: The Indus Valley civilisation had a rudimentary network of sewers built under grid pattern streets, and it was the most advanced seen so far.

Squat toilets (also known as an Arabic, French, Chinese, Japanese, Korean, Iranian, Indian, Turkish or Natural-Position toilet) are used by squatting rather than sitting and are still used by the majority of the world's population. There are several types of squat toilets, but they all consist essentially of a hole in the ground or floor with provisions for human waste.
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